HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 370 CANDLESTICK ROAD 6/7/2021 Commonwealth of Massachusetts
City/Town of o�-�h �r,cioJer
System Pumping Record
Form 4
�?- DEP has provided this form for use by local Boards of Health.Other forms may be used,but the mfort� (b p
substantially the same as that provided here.Before using this form,check with your local Board of Hea�w to etermine the form
they use.The System Pumping Record must be submitted to the local Board of Health or other approving auth r14
days from the pumping date in accordance vr,!h 310 CMR 15.351. �
A. Facility Information TOWN OF NORTH ANDOVER
1. System Location: HEALTH DEPARTMENT
370 Candlestick Road
Address _
North Andover MA 01845
City/Town State Code
2. System Owner:
Kenneth Delatorre
Name
370 Candlestick Road
Address(if different from location)
North Andover MA 01845
Cityfrown State Zip Code
6177178634 xc
Telephone Number
B. Pumping Record
:/18/2021 1500.0000
1. Date of Pumping - 2. Quantity Pumped:
Date Gallons
3. Component: Cesspool(s) Q Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? Yes 0 No If yes, was it cleaned? ❑Yes No
5. Observed condition of component pumped:
1 au}r-Log-solids-_-iieau bctrom slutute -__-
i3a baff3es are- r tart- Main line C-1cal.. IVv- tan c-,--current-
tan s not es ggne3 to Be""use witfi a ter. avers secured. Pum►pe 15V0-9ii ons
.wo and a half foot or solids. Recommended Boost additive,CCLS additive,Frequency
In-crease. _--__
6. System Pumped By:
Marcus Lark
Name Vehicle License Number
,.ind River Environmental, LLC, 577 Main Street, Ste #110, Hudson, MA 0174�
Company - _-_
7. Location where contents were disposed:
Greater Lawrence Sanitary District : 240 Charles Street , North Andover, MA
05/18/2021
__---_..--
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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